You wake up one morning with nausea, abdominal cramps and diarrhea. You realize it must be caused by the past-its-prime chicken you ate last night. More than likely, you have food poisoning. This extremely common illness is caused by eating contaminated food. It is estimated that one in six Americans will suffer from a case of food poisoning every year.

You probably know the common symptoms of bacterial food poisoning, including nausea, vomiting, abdominal cramping and diarrhea. You may have heard of common causes, including E. coli, Listeria, Salmonella and norovirus. However, there are some unusual and rarer causes of food-related illness that you may not know about. Here are a few cases IPC recently handled:

 

Case #1

Two adults called IPC stating after eating barracuda purchased from a grocery store. They were experiencing vomiting and diarrhea. They were also experiencing a very unusual symptom: Hot water tasted cold and cold water tasted hot. The patients were thought to have ciguatera fish poisoning and were referred to a toxicologist for examination and treatment.

Ciguatera fish poisoning is caused by ingesting fish that have a toxin called ciguatoxin. This toxin is commonly found in certain fish that feed on algae containing the toxin. The most common fish that carry this toxin include barracuda, sea bass, grouper and snapper. There are many symptoms of ciguatera fish poisoning, including nausea, vomiting, muscle aches, metallic taste and nerve pain. Patients may also experience a “hot-cold” temperature reversal, which our callers experienced.

As with many poisons and toxins, there is no specific antidote to ciguatera fish poisoning. Patients will receive treatment to support them through the illness and alleviate any symptoms they experience as their body works to clear the toxin. Some symptoms from ciguatera fish poisoning, including nerve pain, can be made worse from vigorous exercise as well as consuming alcohol, nuts, caffeine, chicken, pork and fish. These activities should be avoided for three to six months after the poisoning.

In this case of ciguatera fish poisoning, our patients were prescribed a medication for nerve pain. Both of them made a full recovery without any long-term consequences.

 

Case #2

After eating fresh tuna prepared at a local deli, two people simultaneously broke out with symptoms resembling an allergic reaction. It’s uncommon to see two people suffer from an allergic reaction to the same meal. The IPC poison specialist determined that they were both suffering from scombroid fish poisoning.

Scombroid fish poisoning is caused when an amino acid in the fish, called histidine, is broken down into another compound called histamine. Histamine is one of the compounds that causes allergic reactions. Symptoms of scombroid fish poisoning include a peppery taste in the mouth, a rash, nausea, vomiting, diarrhea and wheezing.

In this case, our patients were treated with over-the-counter medications, including diphenhydramine (also known as Benadryl^®) and famotidine (also known as Pepcid^®). Both patients recovered quickly with no additional complications. However, it is important to know that allergic reactions can cause serious symptoms, including facial swelling, wheezing and dizziness. People experiencing these symptoms should call 911 and get to an emergency room immediately.

 

 

 

 

(Image Source:  DermNet NZ )

 

 

 

 

 

(Image Source:  DermNet NZ )

 

Case #3

In our final case, the IPC received a call about a reaction to shiitake mushrooms. The caller and her friend had eaten some shiitake mushrooms and had developed skin rashes. The patients were thought to have shiitake mushroom poisoning.

Shiitake mushroom poisoning is also known as shiitake dermatitis. It can be caused by eating raw or partially cooked shiitake mushrooms. These mushrooms contain a compound called lentinan, which contributes to the dermatitis. Heat breaks down the lentinan, making it important to only eat fully cooked shiitake mushrooms.

Shiitake dermatitis causes a red rash that usually begins around two days after eating the mushrooms and lasts about 10 days. The initial rash typically presents as a red area that neither hurts nor itches. Red blisters form and harden over the red regions. The rash often looks streaky and may become itchy.

Fortunately, the caller and her friend only experienced minor symptoms. They were treated with over-the-counter medications.

 

 

 

 

(Image Source: National Institute of Health)

    (Image Source:  Wikipepidia )

Although many of the possible gastrointestinal symptoms resulting from foodborne illness are well-known, some symptoms are less common or familiar to people. IPC specialists are trained to recognize, identify and provide treatment recommendations for some of these uncommon illnesses. We encourage you to call the IPC for any known or suspected food poisoning. You can reach a poison specialist at any time of day or night at 1-800-222-1222. The call is free and confidential. Tip: Save the number to your phone since you never know when you’ll need to call!

 

Tony Burda, RPh, DABAT and Allie Herman, PharmD candidate